Between a Rock and a Hard Place: How poverty and lack of agency affect HIV risk behaviors among married women in 25 African countries: A cross-sectional study

Sherafat-Kazemzadeh, Roya; Gaumer, Gary; Hariharan, Dhwani; Sombrio, Anna G; Nandakumar, A

doi:10.7189/jogh.11.04059

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…While earlier studies in PNG have suggested strategies for reducing the gap between socioeconomic quintiles and health among young women,29 there is still evidence of inequalities. Studies have shown links between HIV testing and better adherence to safe sex practices and women’s empowerment in terms of education, financial independence, control over household financial decisions and the power of negotiating sex 52–54. Our findings suggest that there is an urgent need to tailor HIV prevention strategies that are culturally and socioeconomically sensitive to this particular group.…”

Section: Discussionmentioning

confidence: 75%

“…Studies have shown links between HIV testing and better adherence to safe sex practices and women's empowerment in terms of education, financial independence, control over household financial decisions and the power of negotiating sex. [52][53][54] Our findings suggest that there is an urgent need to tailor HIV prevention strategies that are culturally and socioeconomically sensitive to this particular group. Furthermore, the provision of youth-friendly services Open access is crucial to tackle barriers related to poor healthcareseeking behaviors.…”

Section: Discussionmentioning

confidence: 85%

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Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016–2018

Maviso,

Kalembo

2024

BMJ Open

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ObjectiveThe aim of this study was to assess the prevalence of not testing for HIV and its determinants among young adult women aged 15–29 years in Papua New Guinea (PNG).Design and settingThe study used secondary data from the 2016 to 2018 PNG Demographic and Health Survey (PNGDHS), a nationally representative cross-sectional survey that used a two-stage stratified sampling.ParticipantsA total weighed sample of 5164 young adult women aged 15–29 years were included in the analysis.Primary outcome measureEver been tested for HIV was the primary outcome of the study. All analyses were adjusted using survey weights to account for unequal sampling probabilities.ResultsThe prevalence of not testing for HIV was 58.8% (95% CI: 57.4% to 60.1%). The mean age was 21.65 years (SD = 4.23). Of the women who were not tested for HIV, the majority were never married (79.4%), without formal education (63%), not working (60.2%), and from rural areas (62.9%). In the multivariable analysis, those who were never married (adjusted OR (AOR) 4.9, 95% CI 3.6 to 6.6), had poor wealth index (AOR 1.8, 95% CI 1.3 to 2.5), were from rural areas (AOR 2.0, 95% CI 1.5 to 2.6), were from the Momase region (AOR 1.3, 95% CI 1.0 to 1.7), did not read newspapers or magazines (AOR 1.7, 95% CI 1.3 to 2.1), did not listen to the radio (AOR 1.5, 95% CI 1.1 to 2.0), experienced early sexual debut (AOR 1.5, 95% CI 1.1 to 1.9), had one sexual partner (AOR 1.5, 95% CI 1.2 to 2.0) and reported no sexually transmitted infection (STI) in the past 12 months (AOR 1.8, 95% CI 1.1 to 3.1) had higher odds of not testing for HIV.ConclusionsOur study found a very high unmet need for HIV testing among young adult women in PNG. Health promotion programmes should be designed to increase HIV knowledge and access to testing services, particularly targeting young women who are disadvantaged and from rural areas.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 85%

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016–2018

Maviso,

Kalembo

2024

BMJ Open

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“…Studies have shown links between HIV testing and better adherence to safe sex practices and women’s empowerment in terms of education, financial independence, control over household financial decisions, and the power of negotiating sex. [53–55] Our findings suggest that there is an urgent need to tailor prevention strategies for HIV for this group that are sensitive to their culture and socioeconomic context. The focus on improving access to HIV testing services should first be on conceptualising gender in a way that is inclusive.…”

Section: Discussionmentioning

confidence: 97%

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the 2016–2018 Demographic and Health Survey

Maviso

Kalembo

2023

Preprint

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ObjectiveThe aim of this study was to investigate the determinants of not testing for HIV among young adult women aged 15-29 years in Papua New Guinea (PNG).Design and settingThe study used secondary data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS), a nationally representative cross-sectional survey that utilised two-stage cluster sampling. Multivariate logistic regression with complex sample analysis was performed to assess the determinants of not testing for HIV.ParticipantsA total of 8,155 young adult women aged 15-29 years were included in the study.Outcome measureNot testing for HIV.ResultsThe prevalence of not testing for HIV was 71.8% (95% CI: 0.71-0.73). Young adult women who were never married (AOR: 4.9, 95% CI: 3.6-6.6), from rural areas (AOR: 2.0, 95% CI: 1.5-2.6), from poor wealth indices (AOR: 1.8, 95% CI: 1.3-2.5), who did not frequently read newspapers or magazines (AOR: 1.7, 95% CI: 1.3-2.1), who did not frequently listen to the radio (AOR: 1.5, 95% CI: 1.1-2.0), who had initiated sex before the age of 20 (AOR: 1.5, 95% CI: 1.1-1.9), and who had one sexual partner (AOR: 1.5, 95% CI: 1.2-2.0) had higher odds of not testing for HIV compared with their counterparts.ConclusionsOur study found that more than two-thirds of young women in PNG have never been tested for HIV. Socio-demographics, lack of exposure to media, having one sex partner, and not having had an STI in the past 12 months are associated with not testing for HIV. Multi-sectorial policy and programmatic approaches to strengthen community- and home-based testing to complement facility-based HIV services and overcome barriers associated with HIV testing among this population are necessary.

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“…Another study in South Africa reported that early HIV testing appeared to be higher in the lower 40% wealth group than in the higher 40% wealth group [48]. Additionally, a study in the United States, and SSA highlighted how factors such as poverty, unemployment, and inadequate access to healthcare can contribute to women's increased vulnerability to HIV [49][50][51]. These findings suggest that socioeconomic factors play a significant role in the implementation of HIV prevention measures, with wealthier individuals having better access to such services.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and attitude to HIV pre exposure prophylaxis among women in five sub-Saharan African countries: a multilevel model analysis of population-based survey 2021–2022

Terefe,

Jembere,

Asgedom

et al. 2024

BMC Public Health

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Background HIV Pre-Exposure Prophylaxis (HIV PrEP) may help reduce the rate of HIV infection among women in sub-Saharan Africa (SSA). This study aimed to assess women’s knowledge and attitudes toward PrEP, a crucial component of HIV prevention, using nationwide data. It is the first study of its kind conducted in five SSA countries: Burkina Faso, Ghana, Côte d’Ivoire, Kenya, and Tanzania. The primary objective was to examine women’s knowledge and attitudes toward PrEP for the prevention of HIV infection, as well as to explore individual- and community-level factors associated with it. Methods The current study utilized the 2021/22 demographic and health survey datasets from five African nations, namely Burkina Faso, Côte d’Ivoire, Ghana, Kenya, and Tanzania. The analysis was performed using Stata 17. A weighted sample of 77,052 women of reproductive age participated in the survey. Univariate and multivariable multilevel logistic regressions were conducted to assess parameters related to knowledge and attitudes toward PrEP in these countries. In both the univariate regression and the final model, the significance of variables was determined using P values of ≤ 0.2 and < 0.05. Results Overall, only about 13.88 (95% CI: 13.64,14.12) of women had knowledge and attitudes toward HIV PrEP. The highest (34.29%) and lowest (5.61%) values were observed for Kenya and Tanzania respectively. Higher rates of knowledge, and attitude toward HIV PrEP among women were independently associated with age 25–34 years old (AOR = 1.52, 95% CI:1.41,1.64), and 35–49 years old (AOR = 1.56, 95% CI:1.43,1.69), primary education level (AOR = 1.79,95% CI:1.65,1.95), and secondary/higher education level (AOR = 2.92, 95% CI: 2.67,3.20), richer (AOR = 1.14, 95% CI:1.02,1.27), and richest (AOR = 1.21, 95% CI:1.06,1.37), employed women (AOR = 1.82, 95% CI:1.65,1.99), had media exposure (AOR = 1.49,95% CI:1.40,1.59),knowledge of modern contraception (AOR = 2.62, 95% CI: 1.94,3.43), had at least one ANC visit (AOR = 1.99, 95% CI:1.47,2.69), gave birth at health institutions (AOR = 1.17, 95% CI: 1.02,1.37), ever had given birth (AOR = 1.53, 95% CI: 1.41,1.66), female household heads (AOR = 1.24, 95% CI:1.17,1.31), rural women (AOR = 0.83, 95% CI: 0.76,0.89). Similarly, women from communities with high ANC coverage (AOR = 1.84, 95% CI: 1.61,2.11), high community mass media exposure (AOR = 1.62, 95% CI: 1.39,1.88), and high community wealth level (AOR = 1.48, 95% CI: 1.30,1.68), and women from the high illiteracy rate community (AOR = 0.71, 95% CI: 0.61,0.82) showed statistically significant associations with the outcome variable in the final model. Conclusions Less than one-seventh of women exhibited knowledge of and positive attitudes toward HIV PrEP. All stakeholders involved in HIV/AIDS prevention and control have recognized the significance of the factors mentioned above. Enhancing maternal health services, such as promoting institutional delivery, contraception, antenatal care (ANC), and women’s empowerment, alongside harnessing the power of media and embracing these transformative changes, will contribute to a greater understanding of and more favorable attitudes toward HIV PrEP within the population.

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Between a Rock and a Hard Place: How poverty and lack of agency affect HIV risk behaviors among married women in 25 African countries: A cross-sectional study

Cited by 8 publications

References 16 publications

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016–2018

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016–2018

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the 2016–2018 Demographic and Health Survey

Knowledge and attitude to HIV pre exposure prophylaxis among women in five sub-Saharan African countries: a multilevel model analysis of population-based survey 2021–2022

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